Dr Michelle Lavin. Image: RCSI
Dr Michelle Lavin is the first Irish clinician to receive a grant from the AXA Research Fund, which will support the development of a simple tool to reduce maternal mortality.
Researcher Dr Michelle Lavin has received a grant to reduce bleeding during childbirth by diagnosing undetected bleeding disorders, thus reducing maternal mortality rates in Ireland and worldwide.
Working out of the Royal College of Surgeons in Ireland (RCSI), Lavin’s work has been supported by the AXA Research Fund, which specifically directs funding to scientific research dedicated to improving women’s health issues and women’s access to healthcare.
Time to focus on women’s health
“Women’s health has not been a focus of research interest historically. However, it is encouraging that not only research interest but public interest in this area is improving,” said Lavin, from the Irish Centre for Vascular Biology and Department of Molecular and Cellular Therapeutics at RCSI.
In particular, Lavin noted a reluctance to explore issues of gynaecological bleeding. “Research funding is always limited and this area has not been prioritised. However, improvements in women’s health have been shown to have not only an impact on the woman’s health, but also to positively impact on the family unit. From an economic viewpoint, with women contributing more and more to the workforce, there is a clear need to address issues specific to women that may reduce their quality of life, ability to work and overall health.”
Lavin believes access to health information online has helped shape this increased awareness of women’s health issues, driving this area forward as a a focus for further investment and research. However, she said investment in women’s health in Ireland in the past has been “lacking”.
“This applies not only to research, but in the funding of medical services that apply to women’s health, such as contraception, antenatal care and gynaecology. As a society, women’s health has not been prioritised and taboos still exist, impeding open discussion regarding periods, gynaecological health and complications arising from childbirth.
“In the last two years, the issues raised in Ireland as a result of CervicalCheck and the referendum [on the Eighth Amendment] have helped shine a spotlight on women’s health. Now, people are beginning to recognise it as a priority area, not only for the provision of medical care but also research to improve diagnosis, treatment and management of problems specific to women’s health.”
A simple, global solution
Lavin’s PhD research began her focus on gynaecological bleeding, investigating the frequent occurrence of postpartum haemorrhage (PPH) in patients with an undiagnosed low von Willebrand factor (VWF, a protein that helps control bleeding). This bleeding disorder often goes undetected until a major bleed, such as a PPH, occurs.
“Rather than waiting for women to experience a major bleed, my research led me to question how we could we identify these women earlier,” said Lavin.
Lavin found that diagnosis of low VWF meant medical teams were aware of an increased bleeding risk and thus could plan accordingly. This would then reduce the occurrence of PPH worldwide, the rates of which Lavin described as “shocking” with one woman dying every six minutes, according to a 2014 analysis from the World Health Organization.
“It was clear that improved strategies are required in this area. Importantly, any solution had to be cost-effective to administer in order that it could be used in both high- and low-resource settings. By using a paper-based bleeding assessment tool, we have the opportunity to expand this worldwide should it prove effective at preventing PPH.”
If effective, Lavin’s simple screening tool could be integrated into routine obstetric care, and allow appropriate and timely treatments to be ready during birth. “If our study can show that using a simple survey at a woman’s antenatal visit could save her life in the delivery room, it is imperative that we incorporate it into standard practice,” said Lavin.
Next steps
The €1m AXA Research Fund is shared between eight projects, with Lavin receiving a share of €125,000 over two years. She is the first Irish clinician to receive a grant from the fund.
With this “critical” funding, Lavin will establish a PPH-prevention study, enrolling 1,000 pregnant women through partner maternity hospitals in Dublin over the next 18 months.
“From the PPH-prevention study we will then be able to determine if bleeding scores can help predict women at risk of PPH, an important step forward in improving maternal outcomes,” she explained.
“Should bleeding scores prove beneficial in predicting risk of postpartum haemorrhage, our next steps will focus on routine implementation of this tool for all women as part of their routine antenatal risk assessment. Given the short timeframe associated with this study and the low-cost methods of bleeding assessment, it is feasible that a bleeding assessment could be rapidly integrated into current clinical management, even within two to three years.”
